Does adding a delayed phase to cardiac computed tomography for coronary artery evaluation have prognostic value?

Area of Science:

• Cardiovascular Imaging
• Radiology
• Cardiac Computed Tomography

Background:

• Cardiac computed tomography (CCT) offers insights into coronary anatomy and myocardial tissue characteristics.
• Delayed phase imaging, including extracellular volume fraction (ECV) for diffuse fibrosis and late iodine enhancement (LIE) for focal fibrosis, provides complementary information.
• Distinct pathological processes underlie ECV and LIE, suggesting combined assessment could enhance detection of subclinical myocardial injury.

Purpose of the Study:

• To evaluate the prognostic value of LIE and ECV in patients undergoing CCT for coronary artery assessment.
• To determine the association of combined LIE and ECV with clinical outcomes, including all-cause death and cardiovascular hospitalizations.

Main Methods:

• Analysis of 1,207 consecutive patients undergoing CCT.
• Categorization into four groups based on the presence of LIE and elevated ECV.
• Assessment of associations using Cox proportional hazards models and Kaplan-Meier analysis over a mean follow-up of 26.0 months.

Main Results:

• A stepwise increase in risk was observed across the four groups.
• Patients with both LIE and elevated ECV exhibited the highest cumulative incidence of composite events (log-rank p = 0.027).
• This group demonstrated a significantly increased risk for the composite outcome (HR 1.84) and cardiovascular events (HR 2.67).

Conclusions:

• The coexistence of LIE and elevated ECV in patients undergoing CCT is linked to a heightened risk of cardiovascular events.
• Combined assessment of LIE and ECV offers synergistic prognostic value in coronary artery evaluation.
• This dual-marker approach may improve risk stratification in patients evaluated with CCT.